New Delhi. Diabetes is a progressive disease, said Dr KK Aggarwal, President Heart Care Foundation of India. Dr Aggarwal said that an analysis from the United Kingdom Prospective Diabetes Study (UKPDS) found that 50 percent of patients originally controlled with a single drug required the addition of a second drug after three years. After nine years, 75 percent of patients need multiple therapies to achieve the target hemoglobin A1c (HbA1c) value which is the average blood sugar of the last three months.

After a successful initial response to oral therapy, patients fail to maintain target A1c levels (<7 percent) at a rate of 5 to 10 percent per year. That means that all diabetic patients will start with one drug and will invariably end up with three with or without the addition of insulin within ten years.

A1c should be done every three months until <7 percent and then at least every 6 months and should be preferred over the fasting sugar levels. A1c should be kept lower than 7%. Regardless of the initial response to therapy, the natural history of most patients with type 2 diabetes for blood glucose concentrations is to rise gradually with time.

Initial treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise and weight reduction when appropriate. Monotherapy with metformin is indicated for most patients and insulin may be indicated for initial treatment for some. In the absence of contraindications, metformin is usually the initial therapy for most patients with type 2 diabetes.